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  • Title: Abortion mortality, United States, 1972 through 1987.
    Author: Lawson HW, Frye A, Atrash HK, Smith JC, Shulman HB, Ramick M.
    Journal: Am J Obstet Gynecol; 1994 Nov; 171(5):1365-72. PubMed ID: 7977548.
    Abstract:
    OBJECTIVE: The aim of our study was to describe risk factors for legal abortion mortality and the characteristics of women who died of legal abortion complications for the period 1972 through 1987. STUDY DESIGN: We reviewed abortion mortality surveillance data collected by the Division of Reproductive Health, Centers for Disease Control and Prevention, and calculated rates by various demographic and reproductive health variables using the Center for Disease Control and Prevention's abortion surveillance data as denominators. Rates are reported as legal abortion deaths per 100,000 abortions. RESULTS: Between 1972 and 1987, 240 women died as a result of legal induced abortions. The case-fatality rate decreased 90% over time, from 4.1 deaths per 100,000 abortions in 1972 to 0.4 in 1987. Women > or = 40 years old had three times the risk of death as teenagers (relative risk 3.0, 95% confidence interval 1.5 to 6.0), and black women and those of other minority races had 2.5 times the risk of white women (relative risk 2.5, 95% confidence interval 1.9 to 3.2). Abortions at > or = 16 weeks were associated with a risk of death almost 15 times the risk of death from procedures at < or = 12 weeks' gestation. Women undergoing currettage procedures for abortion had a significantly lower risk of death than women undergoing other procedures. Whereas before 1977 infection and hemorrhage were the leading causes of death, during 1977 through 1982 anesthesia complications emerged as one of the leading causes of death and since 1983 have become the most frequent cause. CONCLUSIONS: Although legal induced abortion-related deaths are rare events, our findings suggest that more rigorous efforts are needed to increase the safety of anesthetic methods and anesthetic agents used for abortions and that efforts are still necessary to monitor serious complications of abortion aimed at further reducing risks of death associated with the procedure. Abortion related mortality in the US between 1972 and 1987 amounted to 240 deaths from legal induced abortion and 88 deaths from illegal induced abortion in the US. The study aimed to describe risk factors for legal abortion related mortality based on Centers for Disease Control and Prevention abortion surveillance data. Mortality decreased by 90% from 4.1 deaths/100,000 legal induced abortions in 1972 to 0.4/100,000 in 1987. Reporting which included demographic data on abortion mortality included 29 states between 1983 and 1987. Three time periods were compared: 1972-76, 1977-82, and 1983-87 for age groups under 19 years, 20-29 years, and over 30 years. There were 667 reported deaths during 1972-87, of which 240 were due to legally induced abortion, 88 due to illegal abortions, and 172 due to spontaneous abortions. The case fatality rate for legal abortions during 1972-87 was 1.3 deaths/100,000 legal abortions. Abortion mortality was 2.5 times higher for Black and minority women: 2.3/100,000 compared to 0.9/100,000 for White women. This risk was partially attributed to the greater proportion of later abortions for Black women, which declined over time as did abortion-related mortality. In the Poisson regression analysis, Black race remained a significant risk factor. The risk tripled for women aged over 40 years (3.1/100,000), particularly for those women with 3 or more prior births. The risk by age declined over time and was not a significant risk factor between 1983 and 1987. The highest risk was among women with abortions beyond 20 weeks of gestation (10.4/100,000). About 20% of legal abortion-related deaths were attributed to each of the following causes: infection, embolism, hemorrhage, and anesthesia complications (82% of the 240 reported deaths). Over time, the primary remaining risk between 1983 and 1987 was from general anesthesia. Future abortions should be performed with special attention to choosing and administering anesthesia and to having emergency equipment available for complications from anesthesia.
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